The accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with Apparent Diffusion Coefficients in diagnosis of recurrent cholesteatoma

Osman, Nasr Mohamed M.; Rahman, Ahmed Abdel; Ali, Moustafa Talaat Abdel Hakim

doi:10.1016/j.ejro.2017.03.001

Cited by 19 publications

(15 citation statements)

References 17 publications

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“…Using the ADC maps, paying close attention to location and shape of the lesion on anatomical images and regarding patient's previous medical history helps to avoid interpretation pitfalls. In cholesteatoma substantially lower ADC values (range 0.5-0.9 × 10 -3 mm 2 /s) have been reported when compared with AM (range 0.8-2.0 × 10 -3 mm 2 /s) [18,25,26].…”

Section: Discussionmentioning

confidence: 90%

Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT

et al. 2020

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Purpose Current imaging standard for acute mastoiditis (AM) is contrast-enhanced computed tomography (CT), revealing inflammation-induced bone destruction, whereas magnetic resonance imaging (MRI) outperforms CT in detecting intracranial infection. Our aim was to compare the diagnostic performance of MRI with CT in detecting coalescent AM and see to which extent MRI alone would suffice to diagnose or rule out this condition. Methods The MR images of 32 patients with AM were retrospectively analyzed. Bone destruction was evaluated from T2 turbo spin echo (TSE) and T1 Gd magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images. Intramastoid enhancement and diffusion restriction were evaluated subjectively and intramastoid apparent diffusion coefficient (ADC) values were measured. The MRI findings were compared with contrast-enhanced CT findings of the same patients within 48 h of the MR scan. Results Depending on the anatomical subsite, MRI detected definite bone defects with a sensitivity of 100% and a specificity of 54–82%. Exception was the inner cortical table where sensitivity was only 14% and specificity was 76%. Sensitivity for general coalescent mastoiditis remained 100% due to multiple coexisting lesions. The absence of intense enhancement and non-restricted diffusion had a high negative predictive value for coalescent mastoiditis: an intramastoid ADC above 1.2 × 10−3 mm2/s excluded coalescent mastoiditis with a negative predictive value of 92%. Conclusion The MRI did not miss coalescent mastoiditis but was inferior to CT in direct estimation of bone defects. When enhancement and diffusion characteristics are also considered, MRI enables dividing patients into low, intermediate and high-risk categories with respect to coalescent mastoiditis, where only the intermediate risk group is likely to benefit from additional CT.

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Section: Discussionmentioning

confidence: 90%

Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT

et al. 2020

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“…Diffusion‐weighted imaging (DWI) has emerged as a powerful diagnostic tool for the detection of cholesteatoma and is able to differentiate cholesteatoma from granulation tissue, scar, encephalocele, and benign fluid 1–4 . Non‐echo planar imaging (non‐EPI) DWI sequences, used because of their relative lack of susceptibility artifacts and geometric distortions near the skull base, have reported sensitivity and specificity of 91% and 96% for cholesteatoma detection, respectively 5 .…”

Section: Introductionmentioning

confidence: 99%

Cholesteatoma Localization Using Fused Diffusion‐Weighted Images and Thin‐Slice T2 Weighted Images

et al. 2020

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Background Fusion of diffusion‐weighted imaging (DWI) to computed tomography (CT) has been touted as a possible technique to improve cholesteatomas localization. This study set out to assess the ability of DWI images fused with thin‐slice heavily T2‐weighted images to similarly localize surgically‐confirmed cholesteatomas. Materials and Methods A retrospective review was completed of consecutive patients that underwent MR temporal bone imaging (9/2011–3/2020) with both DWI and thin‐slice T2‐weighted imaging. Included patients underwent surgical resection of primary or recidivistic cholesteatoma after preoperative MR imaging. A neuroradiologist, who was blinded to operative and clinical notes, localized each lesion on both DWI and fused DWI‐T2 images in 11 anatomic subdivisions of the temporal bone. Surgical confirmation of cholesteatoma location was used as the gold standard for comparison. Results Of 24 included examinations, the average age at time of MR was 48.2 ± 24.7 years; 12/24 (50.0%) were female. Five of 24 had primary cholesteatoma, while the remainder had recidivistic disease. Sensitivity, specificity, and accuracy of unfused DWI images were 52.1%, 88.9%, and 75.8%, respectively. Sensitivity, specificity, and accuracy of fused DWI‐T2 images were 57.1%, 94.8%, and 81.8%, respectively. Conclusion Fused DWI‐T2 images outperformed unfused DWI images in the anatomic localization of temporal bone cholesteatomas. This method represents a potential alternative to MR‐CT fusion for pre‐operative cholesteatoma evaluation, and warrants future investigations. Opposed to MR‐CT fusion, this method only necessitates MR sequences and removes the need for additional CT acquisition. Level of Evidence 3 Laryngoscope, 131:E1662–E1667, 2021

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“…In our study we did not evaluate the values of the apparent diffusion coefficient (ADC) derived from DWI. In the literature there are contradictory reports on the importance of ADC map analysis and measurements [11,15,[21][22][23][24][25]. Magnetic field inhomogeneity, size of the lesion (< 3 mm), utility of different MR machines of different vendors, and variable field strengths are the main limitations to obtaining a standardized cut-off value of ADC for cholesteatoma versus other pathologies in the temporal bone.…”

Section: Discussionmentioning

confidence: 99%

The value of different diffusion-weighted magnetic resonance techniques in the diagnosis of middle ear cholesteatoma. Is there still an indication for echo-planar diffusion-weighted imaging?

Piekarek¹,

Zatoński²,

Kolator³

et al. 2022

Pol J Radiol

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Purpose:The aim of the study was to analyse the value of 2 different diffusion-weighted imaging (DWI) techniques (echo-planar imaging [EPI] and on-echo-planar imaging [non-EPI]) in the diagnosis of cholesteatoma. Material and methods:Our material consisted of 32 subjects suspected of cholesteatoma, who underwent magnetic resonance imaging of the temporal bone using both EPI and non-EPI DWI. Two independent readers retrospectively analysed magnetic resonance images. Intra-and interobserver agreements as well sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of both DWI sequences were assessed. Results:Using non-EPI DWI all cholesteatomas were correctly diagnosed by both readers with no false negative nor inconclusive cases and with only one false positive result. Non-EPI DWI revealed high interobserver agreement (k = 1) and high correlation with histopathological results (r = 0.895). EPI DWI misdiagnosed 27-31% of cholesteatomas (false negative results), showing also significantly low interobserver agreement (k = 0.373) and low correlation with histopathological results (r = 0.328 for reader 1 and r = 0.267 for reader 2). Non-EPI DWI revealed very high sensitivity (100%), specificity (83.3%), NPV (100%), and PPV (96.3%) in comparison to EPI DWI, which showed lower sensitivity (69.2%), specificity (66.6-83.3%), . Conclusions:Non-EPI DWI with high sensitivity, specificity, and interobserver agreement is a very reliable technique in detecting middle ear cholesteatoma regardless of the pre-or postoperative state of the ear, and it should entirely replace EPI DWI in clinical practice.

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The accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with Apparent Diffusion Coefficients in diagnosis of recurrent cholesteatoma

Cited by 19 publications

References 17 publications

Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT

Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT

Cholesteatoma Localization Using Fused Diffusion‐Weighted Images and Thin‐Slice T2 Weighted Images

The value of different diffusion-weighted magnetic resonance techniques in the diagnosis of middle ear cholesteatoma. Is there still an indication for echo-planar diffusion-weighted imaging?

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